| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,169 |
2,038 |
$93K |
| D1110 |
Prophylaxis - adult |
1,657 |
1,564 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,857 |
2,737 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,277 |
3,097 |
$45K |
| D2140 |
|
1,048 |
593 |
$44K |
| D0330 |
Panoramic radiographic image |
939 |
894 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
675 |
287 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,137 |
1,043 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,106 |
1,044 |
$26K |
| D0272 |
Bitewings - two radiographic images |
536 |
500 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
156 |
67 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
55 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$468.00 |
| D1999 |
|
568 |
489 |
$0.00 |